Chapter 52: Renal and Urinary Medications

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 33% 2. Platelet count of 400,000 mm3 3. White blood cell count of 6000 mm3 4. Blood urea nitrogen level of 15 mg/dL

1 Rationale: Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is Male: 42% to 52% ; Female: 37% to 47% . Therapeutic effect is seen when the hematocrit reaches between 30% and 33% The normal platelet count is 150,000 to 400,000 mm3. The normal blood urea nitrogen level is 10 to 20 mg/dL. The normal white blood cell count is 5000 to 10,000 mm3. Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin. Test-Taking Strategy: Focus on the subject, a therapeutic effect. Relate the name of the medication, epoetin alfa, to the potential action or effect of erythropoietin. The only laboratory test that would reflect the effect of this medication is a hematocrit of 33%, found in the correct option.

Bethanechol chloride is prescribed for a client with urinary retention. Which health problem would be a contraindication to the administration of this medication? 1. Gastric atony 2. Urinary strictures 3. Neurogenic atony 4. Gastroesophageal reflux

2 Rationale: Bethanechol chloride can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions. Test-Taking Strategy: Focus on the subject, a contraindication to bethanechol chloride. Noting that the question indicates the medication is used for urinary retention may assist in directing you to the correct option.

The nurse is reinforcing discharge instructions to a client receiving sulfadiazine. Which would be included in the list of instructions? 1. Restrict fluid intake. 2. Maintain a high fluid intake. 3. Decrease the dosage when symptoms are improving to prevent an allergic response. 4. If the urine turns dark brown, call the primary health care provider immediately.

2 Rationale: Each dose of sulfadiazine needs to be administered with a full glass of water, and the client needs to maintain a high fluid intake. The medication is more soluble in alkaline urine. The client would not be instructed to taper or discontinue the dose. Some forms of sulfadiazine cause urine to turn dark brown or red. This does not indicate the need to notify the PHCP. Test-Taking Strategy: Focus on the subject, client teaching points related to sulfadiazine. Think about the classification of this medication. Recalling that this medication is used to treat urinary tract infections will direct you to the correct option.

A sulfonamide is prescribed for a client with a urinary tract infection. During review of the client's record, the nurse notes that the client is taking warfarin sodium daily. Which prescription would the nurse anticipate for this client? 1. Discontinuation of warfarin sodium 2. A decrease in the warfarin sodium dosage 3. An increase in the warfarin sodium dosage 4. A decrease in the usual dose of the sulfonamide

2 Rationale: Sulfonamides can potentiate the effects of warfarin sodium, phenytoin, and orally administered hypoglycemics such as tolbutamide. When an oral anticoagulant is combined with a sulfonamide, a decrease in the anticoagulant dosage may be needed. Test-Taking Strategy: Focus on the subject, a sulfonamide and interaction with oral anticoagulants. Knowledge about the medication interactions associated with the use of sulfonamides is needed to answer this question. Remember that a sulfonamide can intensify the effects of oral anticoagulants.

Following kidney transplantation, cyclosporine is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Hemoglobin level of 14.0 g/dL 2. Creatinine level of 0.6 mg/dL 3. Blood urea nitrogen level of 25 mg/dL 4. Fasting blood glucose level of 99 mg/dL

3 Rationale: Cyclosporine is an immunosuppressant. Nephrotoxicity can occur from the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. The normal blood urea nitrogen level is 10 to 20 mg/dL. The normal creatinine level for a male is 0.6 to 1.2 mg/dL and for a female 0.5 to 1.1 mg/dL. Cyclosporine can lower complete blood cell count levels. A normal hemoglobin is Male: 14 to 18 g/dL; Female: 12 to 16 g/dL. A normal hemoglobin is not an adverse effect. Cyclosporine does affect the glucose level. The normal fasting glucose is 70 to 99 mg/dL. Test-Taking Strategy: Focus on the subject, the adverse effects of cyclosporine. Recall that cyclosporine can be nephrotoxic. The correct option is the only one that indicates an increased level of a renal function test. Also, recalling the normal laboratory reference levels will direct you to the correct option, the only abnormal level.

The nurse who is administering bethanechol chloride is monitoring for acute toxicity associated with the medication. The nurse would check the client for which sign of toxicity? 1. Dry skin 2. Dry mouth 3. Bradycardia 4. Signs of dehydration

3 Rationale: Toxicity (overdose) produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously. Test-Taking Strategy: Noting the comparable and alike similarity in options 1, 2, and 4 will assist in eliminating these options. These options all reflect signs of dehydration.

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse would instruct the client to report which symptom if it developed during the course of this medication therapy? 1. Nausea 2. Diarrhea 3. Headache 4. Sore throat

4 Rationale: Clients taking trimethoprim-sulfamethoxazole need to be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client needs to be instructed to notify the primary health care provider (PHCP) if these symptoms occur. The other options do not require PHCP notification. Test-Taking Strategy: Focus on the subject, the symptom to be reported. Knowledge that this medication can cause blood dyscrasias will direct you to the correct option.

The client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client needs to be questioned about the use of which class of medications? 1. Diuretics 2. Antibiotics 3. Antitussives 4. Decongestants

4 Rationale: Episodes of urinary retention can be triggered by certain medications such as decongestants, anticholinergics, and antidepressants. Diuretics, antibiotics, and antitussives generally do not trigger urinary retention. Retention also can be precipitated by other factors such as alcoholic beverages, infection, bed rest, and becoming chilled. Test-Taking Strategy: Focus on the subject, medications that cause urinary retention. The question is asking about medications that could exacerbate or contribute to urinary retention. Diuretics would help voiding; therefore, readily eliminate option 1. Antibiotics would have no effect at all, eliminating option 2. From the remaining options, recalling that medications that contain anticholinergics may cause urinary retention will direct you to option 4.

Phenazopyridine hydrochloride is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. Which instruction would the nurse reinforce to the client? 1. Take the medication at bedtime. 2. Take the medication before meals. 3. Discontinue the medication if a headache occurs. 4. A reddish-orange discoloration of the urine may occur.

4 Rationale: The nurse would instruct the client that a reddish-orange discoloration of urine may occur. The nurse also would instruct the client that this discoloration can stain fabric. The medication needs to be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication. Test-Taking Strategy: Eliminate options 1 and 2 first because they are comparable or alike in that they address time schedules for the administration of the medication. From the remaining options, eliminate option 3 because the nurse would not advise the client to discontinue this medication.

Oxybutynin chloride is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication? 1. Pallor 2. Drowsiness 3. Bradycardia 4. Restlessness

4 Rationale: Toxicity (overdose) of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdose. Test-Taking Strategy: Focus on the subject, toxicity associated with oxybutynin chloride. Knowledge regarding the signs/symptoms related to toxicity is required to answer this question. Remember that restlessness is a sign of toxicity.